Functionalized Hydrogels for Articular Cartilage Tissue Engineering

Articular cartilage(AC)is an avascular and flexible connective tissue located on the bone surface in the diarthrodial joints.AC defects are common in the knees of young and physically active individuals.Because of the lack of suitable tissue-engineered artificial matrices,current therapies for AC defects,espe-cially full-thickness AC defects and osteochondral interfaces,fail to replace or regenerate damaged carti-lage adequately.With rapid research and development advancements in AC tissue engineering(ACTE),functionalized hydrogels have emerged as promising cartilage matrix substitutes because of their favor-able biomechanical properties,water content,swelling ability,cytocompatibility,biodegradability,and lubricating behaviors.They can be rationally designed and conveniently tuned to simulate the extracel-lular matrix of cartilage.This article briefly introduces the composition,structure,and function of AC and its defects,followed by a comprehensive review of the exquisite(bio)design and(bio)fabrication of func-tionalized hydrogels for AC repair.Finally,we summarize the challenges encountered in functionalized hydrogel-based strategies for ACTE both in vivo and in vitro and the future directions for clinical translation.

Robotic in situ bioprinting for cartilage tissue engineering

Articular cartilage damage caused by trauma or degenerative pathologies such as osteoarthritis can result in significant pain,mobility issues,and disability.Current surgical treatments have a limited capacity for efficacious cartilage repair,and long-term patient outcomes are not satisfying.Three-dimensional bioprinting has been used to fabricate biochemical and biophysical environments that aim to recapitulate the native microenvironment and promote tissue regeneration.However,conventional in vitro bioprinting has limitations due to the challenges associated with the fabrication and implantation of bioprinted constructs and their integration with the native cartilage tissue.In situ bioprinting is a novel strategy to directly deliver bioinks to the desired anatomical site and has the potential to overcome major shortcomings associated with conventional bioprinting.In this review,we focus on the new frontier of robotic-assisted in situ bioprinting surgical systems for cartilage regeneration.We outline existing clinical approaches and the utilization of robotic-assisted surgical systems.Handheld and robotic-assisted in situ bioprinting techniques including minimally invasive and non-invasive approaches are defined and presented.Finally,we discuss the challenges and potential future perspectives of in situ bioprinting for cartilage applications.

Recent Progress in Cartilage Tissue Engineering--Our Experience and Future Directions

Given the limited spontaneous repair that follows cartilage injury, demand is growing for tissue engi- neering approaches for cartilage regeneration. There are two major applications for tissue-engineered cartilage. One is in orthopedic surgery, in which the engineered cartilage is usually used to repair cartilage defects or loss in an articular joint or meniscus in order to restore the joint function. The other is for head and neck reconstruction, in which the engineered cartilage is usually applied to repair cartilage defects or loss in an auricle, trachea, nose, larynx, or eyelid. The challenges faced by the engineered car- tilage for one application are quite different from those faced by the engineered cartilage for the other application. As a result, the emphases of the engineering strategies to generate cartilage are usually quite different for each application. The statuses of preclinical animal investigations and of the clinical translation of engineered cartilage are also at different levels for each application. The aim of this review is to provide an opinion piece on the challenges, current developments, and future directions for cartilage engineering for both applications.

Cartilage and facial muscle tissue engineering and regeneration： a mini review

Cartilage and facial muscle tissue provide basic yet vital functions for homeostasis throughout the body, making human survival and function highly dependent upon these somatic components. When cartilage and facial muscle tissues are harmed or completely destroyed due to disease, trauma, or any other degenerative process, homeostasis and basic body functions consequently become negatively affected. Although most cartilage and cells can regenerate themselves after any form of the aforementioned degenerative disease or trauma, the highly specific characteristics of facial muscles and the specific structures of the cells and tissues required for the proper function cannot be exactly replicated by the body itself. Thus, some form of cartilage and bone tissue engineering is necessary for proper regeneration and function. The use of progenitor cells for this purpose would be very beneficial due to their highly adaptable capabilities, as well as their ability to utilize a high diffusion rate, making them ideal for the specific nature and functions of cartilage and facial muscle tissue. Going along with this, once the progenitor cells are obtained, applying them to a scaffold within the oral cavity in the affected location allows them to adapt to the environment and create cartilage or facial muscle tissue that is specific to the form and function of the area. The principal function of the cartilage and tissue is vascularization, which requires a specific form that allows them to aid the proper flow of bodily functions related to the oral cavity such as oxygen flow and removal of waste. Facial muscle is also very thin, making its reproduction much more possible. Taking all these into consideration, this review aims to highlight and expand upon the primary benefits of the cartilage and facial muscle tissue engineering and regeneration, focusing on how these processes are performed outside of and within the body.

In vitro and In vivo Evaluation of the Developed PLGA/HAp/Zein Scaffolds for Bone-Cartilage Interface Regeneration

Objective To investigate the effect of electronspun PLGA/HAp/Zein scaffolds on the repair of cartilage defects. Methods The PLGA/HAp/Zein composite scaffolds were fabricated by electrospinning method. The physiochemical properties and biocompatibility of the scaffolds were separately characterized by scanning electron microscope （SEM）, transmission electron microscope （TEM）, and fourier transform infrared spectroscopy （FTIR）, human umbilical cord mesenchymal stem cells （hUC-MSCs） culture and animal experiments. Results The prepared PLGA/HAp/Zein scaffolds showed fibrous structure with homogenous distribution, hUC-MSCs could attach to and grow well on PLGA/HAp/Zein scaffolds, and there was no significant difference between cell proliferation on scaffolds and that without scaffolds （P〉0.05）. The PLGA/HAp/Zein scaffolds possessed excellent ability to promote in vivo cartilage formation. Moreover, there was a large amount of immature chondrocytes and matrix with cartilage lacuna on PLGA/HAp/Zein scaffolds. Conclusion The data suggest that the PLGA/HAp/Zein scaffolds possess good biocompatibility, which are anticipated to be potentially applied in cartilage tissue engineering and reconstruction.

Progress and prospect of technical and regulatory challenges on tissue-engineered cartilage as therapeutic combination product

Hyaline cartilage plays a critical role in maintaining joint function and pain.However,the lack of blood supply,nerves,and lymphatic vessels greatly limited the self-repair and regeneration of damaged cartilage,giving rise to various tricky issues in medicine.In the past 30 years,numerous treatment techniques and commercial products have been developed and practiced in the clinic for promoting defected cartilage repair and regeneration.Here,the current therapies and their relevant advantages and disadvantages will be summarized,particularly the tissue engineering strategies.Furthermore,the fabrication of tissue-engineered cartilage under research or in the clinic was discussed based on the traid of tissue engineering,that is the materials,seed cells,and bioactive factors.Finally,the commercialized cartilage repair products were listed and the regulatory issues and challenges of tissue-engineered cartilage repair products and clinical application would be reviewed.

Articular cartilage and osteochondral tissue engineering techniques:Recent advances and challenges

In spite of the considerable achievements in the field of regenerative medicine in the past several decades,osteochondral defect regeneration remains a challenging issue among diseases in the musculoskeletal system because of the spatial complexity of osteochondral units in composition,structure and functions.In order to repair the hierarchical tissue involving different layers of articular cartilage,cartilage-bone interface and subchondral bone,traditional clinical treatments including palliative and reparative methods have showed certain improvement in pain relief and defect filling.It is the development of tissue engineering that has provided more promising results in regenerating neo-tissues with comparable compositional,structural and functional characteristics to the native osteochondral tissues.Here in this review,some basic knowledge of the osteochondral units including the anatomical structure and composition,the defect classification and clinical treatments will be first introduced.Then we will highlight the recent progress in osteochondral tissue engineering from perspectives of scaffold design,cell encapsulation and signaling factor incorporation including bioreactor application.Clinical products for osteochondral defect repair will be analyzed and summarized later.Moreover,we will discuss the current obstacles and future directions to regenerate the damaged osteochondral tissues.

Effect of porosities of bilayered porous scaffolds on spontaneous osteochondral repair in cartilage tissue engineering

Poly(lactide-co-glycolide)-bilayered scaffolds with the same porosity or different ones on the two layers were fabricated,and the porosity effect on in vivo repairing of the osteochondral defect was examined in a comparative way for the first time.The constructs of scaffolds and bone marrow-derived mesenchymal stem cells were implanted into pre-created osteochondral defects in the femoral condyle of New Zealand white rabbits.After 12 weeks,all experimental groups exhibited good cartilage repairing according to macroscopic appearance,cross-section view,haematoxylin and eosin staining,toluidine blue staining,immunohistochemical staining and real-time polymerase chain reaction of characteristic genes.The group of 92%porosity in the cartilage layer and 77%porosity in the bone layer resulted in the best efficacy,which was understood by more biomechanical mimicking of the natural cartilage and subchondral bone.This study illustrates unambiguously that cartilage tissue engineering allows for a wide range of scaffold porosity,yet some porosity group is optimal.It is also revealed that the biomechanical matching with the natural composite tissue should be taken into consideration in the design of practical biomaterials,which is especially important for porosities of a multi-compartment scaffold concerning connected tissues.

Microcarriers in application for cartilage tissue engineering: Recent progress and challenges

Successful regeneration of cartilage tissue at a clinical scale has been a tremendous challenge in the past decades. Microcarriers (MCs), usually used for cell and drug delivery, have been studied broadly across a wide range of medical fields, especially the cartilage tissue engineering (TE). Notably, microcarrier systems provide an attractive method for regulating cell phenotype and microtissue maturations, they also serve as powerful injectable carriers and are combined with new technologies for cartilage regeneration. In this review, we introduced the typical methods to fabricate various types of microcarriers and discussed the appropriate ma-terials for microcarriers. Furthermore, we highlighted recent progress of applications and general design prin-ciple for microcarriers. Finally, we summarized the current challenges and promising prospects of microcarrier-based systems for medical applications. Overall, this review provides comprehensive and systematic guidelines for the rational design and applications of microcarriers in cartilage TE.

Mesenchymal stem cells loaded on 3D-printed gradient poly(e-caprolactone)/methacrylated alginate composite scaffolds for cartilage tissue engineering

Cartilage has limited self-repair ability due to its avascular,alymphatic and aneural features.The combination of three-dimensional(3D)printing and tissue engineering provides an up-and-coming approach to address this issue.Here,we designed and fabricated a tri-layered(superficial layer(SL),middle layer(ML)and deep layer(DL))stratified scaffold,inspired by the architecture of collagen fibers in native cartilage tissue.The scaffold was composed of 3D printed depth-dependent gradient poly(e-caprolactone)(PCL)impregnated with methacrylated alginate(ALMA),and its morphological analysis and mechanical properties were tested.To prove the feasibility of the composite scaffolds for cartilage regeneration,the viability,proliferation,collagen deposition and chondrogenic differentiation of embedded rat bone marrow mesenchymal stem cells(BMSCs)in the scaffolds were assessed by Live/dead assay,CCK-8,DNA content,cell morphology,immunofluorescence and real-time reverse transcription polymerase chain reaction.BMSCs-loaded gradient PCL/ALMA scaffolds showed excellent cell survival,cell proliferation,cell morphology,collagen II deposition and hopeful chondrogenic differentiation compared with three individual-layer scaffolds.Hence,our study demonstrates the potential use of the gradient PCL/ALMA construct for enhanced cartilage tissue engineering.

Preparation and characterization of methacrylated gelatin/bacterial cellulose composite hydrogels for cartilage tissue engineering

Methacrylated gelatin(GelMA)/bacterial cellulose(BC)composite hydrogels have been successfully prepared by immersing BC particles in GelMA solution followed by photo-crosslinking.The morphology of GelMA/BC hydrogel was examined by scanning electron microscopy and compared with pure GelMA.The hydrogels had very well interconnected porous network structure,and the pore size decreased from 200 to 10 mm with the increase of BC content.The composite hydrogels were also characterized by swelling experiment,X-ray diffraction,thermogravimetric analysis,rheology experiment and compressive test.The composite hydrogels showed significantly improved mechanical properties compared with pure GelMA.In addition,the biocompatility of composite hydrogels were preliminarily evaluated using human articular chondrocytes.The cells encapsulated within the composite hydrogels for 7 days proliferated and maintained the chondrocytic phenotype.Thus,the GelMA/BC composite hydrogels might be useful for cartilage tissue engineering.

Chondroinductive/chondroconductive peptides and their-functionalized biomaterials for cartilage tissue engineering

The repair of articular cartilage defects is still challenging in the fields of orthopedics and maxillofacial surgery due to the avascular structure of articular cartilage and the limited regenerative capacity of mature chondrocytes.To provide viable treatment options,tremendous efforts have been made to develop various chondrogenically-functionalized biomaterials for cartilage tissue engineering.Peptides that are derived from and mimic the functions of chondroconductive cartilage extracellular matrix and chondroinductive growth factors,represent a unique group of bioactive agents for chondrogenic functionalization.Since they can be chemically synthesized,peptides bear better reproducibility,more stable efficacy,higher modifiability and yielding efficiency in comparison with naturally derived biomaterials and recombinant growth factors.In this review,we summarize the current knowledge in the designs of the chondroinductive/chondroconductive peptides,the underlying molecular mechanisms and their-functionalized biomaterials for cartilage tissue engineering.We also systematically compare their in-vitro and in-vivo efficacies in inducing chondrogenesis.Our vision is to stimulate the development of novel peptides and their-functionalized biomaterials for cartilage tissue engineering.

A HYBRID SCAFFOLD OF POLY(LACTIDE-CO-GLYCOLIDE) SPONGE FILLED WITH FIBRIN GEL FOR CARTILAGE TISSUE ENGINEERING

The poly（lactide-co-glycolide）（PLGA） sponge fabricated by a gelatin porogen leaching method was filled with fibrin gel to obtain a hybrid scaffold for chondrocytes culture in vitro.The fibrin gel evenly distributed in the hybrid scaffold with visible fibrinogen fibers after drying.In vitro culture it was found that in the hybrid scaffold the chondrocytes distributed more evenly and kept a round morphology as that in the normal cartilage.Although the chondrocytes seeded in the control PLGA sponges showed similar proliferation behavior with that in the hybrid scaffolds,they were remarkably elongated,forming a fibroblast-like morphology.Moreover,a larger amount of glycosaminoglycans was secreted in the hybrid scaffolds than that in the PLGA sponges after in vitro culture of chondrocytes for 4 weeks.The results suggest that the fibrin/PLGA hybrid scaffold may be favorably applied for cartilage tissue engineering.

Adipose tissue-derived mesenchymal stem cells and chitosan/poly(vinyl alcohol)nanofibrous scaffolds for cartilage tissue engineering

Osteoarthritis(OA)has been defined as a chronic inflammatory joint disease characterized by progressive articular cartilage degeneration.Recently growing interest in regenerative medicine,using cell therapy and tissue engineering,where cellular components in combination with engineered scaffolds and bioactive materials were used to induce functional tissue regeneration.In the present study,nanofibrous scaffold based on chitosan(CS)/poly(vinyl alcohol)(PVA)were used to develop biologically functionalized biomaterial to mimic the extracellular matrix,allowing the human adipose tissue derived mesenchymal stem cells(ADSCs)to proliferate and differentiate to chondrogenic cells.The morphology of the nanofibrous mat was examined using field emission scanning electron microscope(FE/SEM).The characteristic functional groups and the nature of the chemical bonds between atoms were evaluated using Fourier transform infrared spectroscopy(FTIR)spectrum.Characterization of the seeded cells was morphologically evaluated by scanning electron microscopy and by flow cytometry for the expression of the stem cell surface markers.The differentiation potential was verified after chondrogenic induction by analyzing the expression of chondrogenic marker genes using real-time(RT PCR).Current study suggest significant potential for the use of ADSCs with the nanofibrous scaffolds in improving the osteoarthritis pathology.

The application of ECM-derived biomaterials in cartilage tissue engineering

Given the tremendous increase in the risks of cartilage defects in the sports and aging population,current treatments are limited,and new repair strategies are needed.Cartilage tissue engineering(CTE)is a promising approach to handle this burden and several fabrication technologies and biomaterials have been developed these years.The extracellular matrix(ECM)of cartilage consists of a tissue-specific 3D microenvironment with excellent biomechanical and biochemical properties,which regulates cell proliferation,adhesion,migration,and differentiation,thus attracting a great deal of attention to the rapid development of CTE based on ECM components.New generations of biomaterials are being developed rapidly for use as scaffolds to mimic the natural ECM environment.In this review,we discuss such CTE scaffolds based on ECM-derived biomaterials by reviewing the biomaterials for CTE,the applications in different scaffolds and their processing approaches,as well as the current clinical applications of those ECM-based CTE scaffolds.

Mechanical environment for in vitro cartilage tissue engineering assisted by in silico models

Mechanobiological study of chondrogenic cells and multipotent stem cells for articular cartilage tissue engineering(CTE)has been widely explored.The mechanical stimulation in terms of wall shear stress,hydrostatic pressure and mechanical strain has been applied in CTE in vitro.It has been found that the mechanical stimulation at a certain range can accelerate the chondrogenesis and articular cartilage tissue regeneration.This review explicitly focuses on the study of the influence of the mechanical environment on proliferation and extracellular matrix production of chondrocytes in vitro for CTE.The multidisciplinary approaches used in previous studies and the need for in silico methods to be used in parallel with in vitro methods are also discussed.The information from this review is expected to direct facial CTE research,in which mechanobiology has not been widely explored yet.

Does Making Method of Alginate Hydrogel Influence the Chondrogenic Differentiation of Human Mesenchymal Stem Cells?

To overcome cartilage injury, strategies have been developed in the last few years based on tissue engineering to rebuild the defects. Cartilage engineering is principally based on three main biological factors: cells (native cells (chondrocytes) or a more primitive ones as mesenchymal stem cells), scaffolds and functionalization factors (growth factors, mechanical stimulation and/or hypoxia). Cartilage tissue engineering strategies generally result in homogeneous tissue structures with little resemblance to native zonal organization of articular cartilage. The main objective of our work concerns the buildup of complex biomaterials aimed at reconstructing biological tissue with three dimensional cells construction for mimicking cartilage architecture. Our strategy is based on structures formation by simple and progressive spraying of mixed alginate hydrogel and human mesenchymal stem cells (hMSC). In this work, the comportment of cells and more precisely their chondrogenic differentiation potential is compared to a traditional making process: the mold. We report here that spraying method allowed to product a scaffold with hMSC that confer a favorable environment for neocartilage construction.

Strategies to minimize hypertrophy in cartilage engineering and regeneration

Due to a blood supply shortage,articular cartilage has a limited capacity for selfhealing once damaged.Articular chondrocytes,cartilage progenitor cells,embryonic stem cells,and mesenchymal stem cells are candidate cells for cartilage regeneration.Significant current attention is paid to improving chondrogenic differentiation capacity;unfortunately,the potential chondrogenic hypertrophy of differentiated cells is largely overlooked.Consequently,the engineered tissue is actually a transient cartilage rather than a permanent one.The development of hypertrophic cartilage ends with the onset of endochondral bone formation which has inferior mechanical properties.In this review,current strategies for inhibition of chondrogenic hypertrophy are comprehensively summarized;the impact of cell source options is discussed;and potential mechanisms underlying these strategies are also categorized.This paper aims to provide guidelines for the prevention of hypertrophy in the regeneration of cartilage tissue.This knowledge may also facilitate the retardation of osteophytes in the treatment of osteoarthritis.

Engineering osteoarthritic cartilage model through differentiating senescent human mesenchymal stem cells for testing disease-modifying drugs

Significant cellular senescence has been observed in cartilage harvested from patients with osteoarthritis(OA).In this study,we aim to develop a senescence-relevant OA-like cartilage model for developing disease-modifying OA drugs(DMOADs).Spe-cifically,human bone marrow-derived mesenchymal stromal cells(MSCs)were expanded in vitro up to passage 10(P10-MSCs).Following their senescent phenotype formation,P10-MSCs were subjected to pellet culture in chondrogenic medium.Results from qRT-PCR,histology,and immunostaining indicated that cartilage generated from P10-MSCs displayed both senescent and OA-like phenotypes without using other OA-inducing agents,when compared to that from normal passage 4(P4)-MSCs.Interestingly,the same gene expression differences observed between P4-MSCs and P10-MSC-derived cartilage tissues were also observed between the preserved and damaged OA cartilage regions taken from human samples,as demonstrated by RNA sequencing data and other analysis methods.Lastly,the utility of this senescence-initiated OA-like cartilage model in drug development was assessed by testing several potential DMOADs and senolytics.The results suggest that pre-existing cellular senescence can induce the generation of OA-like changes in cartilage.The P4-and P10-MSCs derived cartilage models also represent a novel platform for predicting the efficacy and toxicity of potential DMOADs on both preserved and damaged cartilage in humans.